tbuckley/cabot-search huggingface dataset:
Abstract 10622: Association of Sustained Ventricular Arrhythmias and Increased Cardiac Metabolic Activity Mimicking Cardiac Sarcoidosis
Authors: Boldizsar Kovacs, Andreas A Giannopoulos, Frank Bogun, Aju P Pazhenkottil, Nicole R Bonetti, Robert Manka, Argelia Medeiros Domingo, Frank Ruschitzka, Firat Duru, Philipp A Kaufmann, Ronny R Buechel, Ardan M Saguner
Journal: Circulation (2022)

Introduction: Cardiac sarcoidosis (CS) is increasingly diagnosed using 18F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT). Patients with sustained ventricular tachycardia/fibrillation (VT/VF) and a positive FDG-PET/CT suggestive of CS often receive immunosuppressive therapy even in the absence of histologic documentation of non-caseating granulomas. Hypothesis: FDG-PET/CT performed early after sustained VT/VF can lead to increased myocardial FDG uptake mimicking CS. Methods: Consecutive patients with non-ischemic cardiomyopathy presenting with sustained VT/VF that underwent FDG-PET/CT immediately following the arrhythmic event were prospectively recruited. Patients with increased metabolic activity consistent with myocardial inflammation were followed. All patients received guideline-directed medical therapy, but without immunosuppressive therapy. Repeat FDG-PET/CT was performed ≥30 days after the last sustained VT/VF episode. Results: Six patients were enrolled with a mean age of 57.1 years (± 5.6), and a left ventricular ejection fraction of 47.5% (±14.8). Coronary artery disease and acute perimyocarditis were excluded. Initial presentation was electrical storm in 2 (33%), appropriate ICD or external shock in 3 (50%) and ATP in 1 (17%) case, respectively. Baseline FDG-PET/CT was performed a median 5.5 days (range 3-17) after sustained VT/VF termination. Distribution of metabolic activity was focal-multifocal in 4 (66%), focal-diffuse in 1 (17%) and focal in 1 (17%) case, respectively. Median SUVmax was 6.8 (range 4.9-18). No extracardiac metabolic foci were observed and histologic diagnosis of non-caseating granuloma could not be established in any patient. Repeat FDG-PET/CT (median after 139, range 38-448 days) showed complete FDG uptake regression in all patients. Final diagnosis of arrhythmogenic cardiomyopathy was made in all patients, and genetic testing was performed. Conclusion: Prolonged VT/VF episodes may result in increased myocardial FDG uptake, potentially leading to an overdiagnosis of CS. FDG-PET/CT to screen for CS should be performed at a VT/VF-free interval prior to immunosuppressive therapy.
Abstract 10218: Differences in Treadmill Exercise Stress Testing Parameters Among Electronic Cigarette Vapers, Combustible Cigarette Smokers, and Controls: The Clues Study
Authors: Christina M Hughey, Thomas M Piasecki, Claudia E Korcarz, Kristin M Hansen, Nancy R Ott, Matthew C Tattersall, Michael C Fiore, Timothy B Baker, James H Stein
Journal: Circulation (2022)

Background: Use of electronic nicotine delivery devices is increasing but their effects on exercise function are not well-characterized. We hypothesized that treadmill stress test outcomes would differ between chronic electronic cigarette users (“vapers”), combustible cigarette users (“smokers”), and non-smoking/non-vaping controls. Methods: CLUES (HL1393301) was a cross-sectional study of 395 individuals: 164 exclusive vapers (exhaled carbon monoxide [CO] &lt;5 ppm, positive urine NicCheck I), 117 exclusive smokers (CO &gt;5 ppm, positive urine NicCheck I), and 114 non-vaping/non-smoking controls (CO &lt;5 ppm, negative urine NicCheck I). Participants completed a symptom-limited Balke treadmill stress test protocol, a mean (SD) of 91.3 (16.2) minutes after vaping, smoking, or resting. Outcome measures were peak achieved metabolic equivalents (METs), rate-pressure product (RPP, peak heart rate [HR]*systolic blood pressure), HR reserve (peak HR/[220-age]), and 60-second HR recovery (HRR60). Group differences were compared by general linear models with omnibus p-values adjusted for age, race, and sex and with post-hoc t-tests using Bonferroni-corrected p-values. Results: Vapers were 27.4 (10.6) years old (39% female, 86% white) and had vaped for 4.1 (2.7) years (16.3 [30.0] vape-years). Smokers were 42.8 (13.8) years old (44% female, 56% white) and had smoked for 23.0 (13.0) years (28.7 [26.5] pack-years). Controls were 30.8 (11.9) years old (50% female, 69% white). Age, race, and sex-adjusted mean (95% CIs) outcome values by group are in the Figure. Vapers performed worse than controls on all 4 exercise parameters: peak METs (p&lt;0.001), peak RPP (p=0.020), HR reserve (p&lt;0.001), and HRR60 (p=0.025) with intermediate values compared to smokers. Conclusion: Vapers consistently performed worse than controls on 4 treadmill exercise parameters that predict adverse cardiovascular disease outcomes with intermediate values compared to smokers.
Abstract 10594: Cardiac Tamponade in a Covid-19 Positive Patient With Idiopathic Capillary Leak Syndrome: A Perilous Combination
Authors: Kim Eloise Biong, Lois P Lapitan, Raul L Lapitan
Journal: Circulation (2022)

Introduction: Clarkson’s disease, more known as idiopathic systemic capillary leak syndrome (SCLS) is a rare condition characterized by hypotensive episodes due to capillary hyperpermeability and can manifest as fluid accumulation in any organ or potential space. This may cause a range of complications: respiratory failure (from pulmonary edema or pleural effusion), mesenteric hypoperfusion (from hepatic congestion and severe intestinal edema), compartment syndrome and rhabdomyolysis, and even shock from hypovolemia or cardiac tamponade. Very few cases of cardiac tamponade in Clarkson's disease and COVID-19 have been reported, and when present, is certainly a serious and life-threatening complication. Case Summary: A 44-year-old female - with prior episodes of angioedema, pleural and pericardial effusions aggravated by menstruation and infection - presented with hypotension and diaphoresis. She was exposed to a COVID patient and eventually tested positive for COVID-19 infection. Persistent hypotension warranted triple inotropic support. Initial laboratories revealed hemoconcentration and hypoalbuminemia. Urinalysis was normal. 2D echocardiography showed normal left ventricular ejection fraction but with large pericardial effusion and signs of cardiac tamponade, hence, she underwent emergency pericardial windowing. She then developed pleural effusion which was drained surgically. Hepatitis, mycoplasmal and Epstein-Barr virus were negative. Direct and indirect Coomb’s test, and Lupus panel were unremarkable. Serum free light chain panel, immunopathology and C1 inhibitor results were non-diagnostic. Patient was managed as a case of idiopathic SCLS or Clarkson's disease. Methylprednisolone pulse therapy (MPPT) and intravenous immunoglobulin (IVIg) were administered. Patient was discharged with tapering doses of oral steroids and scheduled monthly IVIg infusion. Conclusions: Cardiac tamponade is a very rare but life-threatening complication of Clarkson’s disease, and on top of a COVID-19 infection, warrants emergent intervention. The pathogenesis is not yet fully elucidated. Diagnosis of SCLS is challenging thus recurrent pericardial and pleural effusions should raise the clinician’s index of suspicion.
Abstract 10786: Cardiac Muscle Patches Containing Four Types of Cardiac Cells Derived From Human Pluripotent Stem Cells Improve Recovery From Cardiac Injury
Authors: Xi Lou, Xi Lou, Yawen Tang, Lei Ye, Danielle Pretorius, Vladimir G Fast, Asher Kahn-Krell, Jue Zhang, Jianhua Zhang, Aijun Qiao, Timothy J Kamp, James A Thomson, Gangjian Qin, Jianyi Zhang
Journal: Circulation (2022)

Introduction: We have shown that human cardiac muscle patches (hCMPs) containing three different types of cardiac cells—cardiomyocytes (CMs), smooth-muscle cells (SMCs), and endothelial cells (ECs), all of which were differentiated from human pluripotent stem cells (hPSCs)—significantly improved cardiac function, infarct size, and hypertrophy in a pig model of myocardial infarction (MI). However, hPSC-CMs are phenotypically immature, which may lead to arrythymogenic concerns; thus, since hPSC-derived cardiac fibroblasts (hPSC-CFs) appear to enhance the maturity of hPSC-CMs, we compared hCMPs containing hPSC-CMs, -SMCs, -ECs, and -CFs (4TCC-hCMPs) with a second hCMP construct that lacked hPSC-CFs but was otherwise identical (3TCC-hCMPs). Methods: hCMPs were generated in a fibrin scaffold. MI was induced in SCID mice through permanent coronary artery (LAD) ligation, followed by treatment with cardiac muscle patches. Animal groups included: MI heart treated with 3TCC-hCMP; with 4TCC-hCMP; MI heart treated with no patch (MI group) and sham group. Cardiac function was evaluated via echocardiography, and cell engraftment rate while infarct size was evaluated histologically at four weeks after patch transplantation. Results: The results from experiments in cultured hCMPs demonstrate: 1) that structural, metabolic, and ion-channel markers for CM maturation were significantly more abundant in 4TCC-hCMPs; and 2) that conduction velocities and action-potential durations were significantly greater in hPSC-CMs from 4TCC-hCMPs (18 cm/s ± 0.72 vs. 31 cm/s ± 3.23, p&lt;0.005, 3TCC vs. 4TCC). Furthermore, when 3TCC- and 4TCC-hCMPs were compared in a mouse MI model, measures of cardiac function ( EF: 41.55% ± 0.92 vs. 49.18% ± 0.86, p&lt;0.05, 3TCC vs. 4TCC), infarct size (39.23% ± 4.28 vs. 22.72% ± 0.98, p&lt;0.05, 3TCC vs. 4TCC), hypertrophy, and CM engraftment were significantly better in animals treated with 4TCC-hCMPs than in the 3TCC-hCMP-treatment group (8.56% ± 1.79 vs. 15.99% ± 1.56, p&lt;0.05, 3TCC vs. 4TCC). Conclusions: These results demonstrate that the inclusion of hPSC-CFs in hCMP manufacture promotes hPSC-CM maturation and increases the efficacy of hCMPs for myocardial repair.
Abstract 10992: Higher Social Vulnerability is Correlated With Maladaptive Coping in Informal Caregivers of Adults With Heart Failure
Authors: Austin M Matus, Ryan Quinn, Gladys Thomas, Miatta Goba, Jenna Garo, debbie Gordon, Barbara J Riegel
Journal: Circulation (2022)

Background: Social factors are known to influence health outcomes, but the mechanism by which these factors exert their influence is unclear. We explored the relationships between social vulnerability, stress, and coping in a sample of adults caring for patients with chronic heart failure (HF). Methods: Baseline data from a sample of 212 caregivers was analyzed. Social vulnerability (SV) was measured using a modification of the PRAPARE tool with 14 categories (i.e., sex, race, ethnicity, employment, veteran status, education, income, insurance, material security, transportation, social integration, social support, need to support others, early retirement for caregiving) tallied to yield a score between 0-22; higher scores indicate higher SV. Stress was measured with the Perceived Stress Scale (higher is worse). Coping styles were measured as active (scores: 0-45), avoidant (0-30), and minimization (0-30). Higher scores indicate more use of that style. Correlation analysis was used to explore relationships between SV, stress, and coping. Multivariable regression analysis with stepwise variable selection was used to identify which SV factors were the best determinants of coping styles. Results: The sample was predominately White (61.2 %), female (84.2%) older adults ( x 55.2 + 14 years). SV scores were low (range 0-14, 4.0 ± 2.2). SV exhibited a weak correlation with stress (r = .17, p = 0.01) and was not significantly associated with active coping (r = .13, p = 0.05). SV was most strongly correlated with avoidant (r = .30, p &lt; 0.0001) and minimization coping (r = .25, p &lt; 0.001) styles. In multivariable analysis, race, income, and ‘supporting others’ were the strongest predictors of avoidant coping; avoidance scores were 2.5 + 0.9 units greater for non-White caregivers (p&lt;0.0001), 3.1 + 1.3 units greater (p&lt;0.05) for low-income caregivers, and 1.9 + 0.6 units greater (p&lt;0.001) for each additional person supported. Race was the strongest determinant of minimization coping; minimization scores were 4.5 + 0.8 units greater for non-White caregivers (p &lt; 0.0001). Conclusion: These results suggest that caregivers with higher social vulnerability may be avoiding and minimizing to cope with the challenges associated with caregiving.
Abstract 10908: The Association of Duration of Resuscitation and Long-Term Survival and Functional Outcomes After Out-of-Hospital Cardiac Arrest
Authors: Jocelyn Chai, Christopher B Fordyce, Meijiao Guan, Karin Humphries, Jacob Hutton, Jim Christenson, Brian Grunau
Journal: Circulation (2022)

Introduction: Longer emergency medical system (EMS) CPR-to-ROSC interval has been shown to be linearly associated with worse hospital discharge outcomes for out-of-hospital cardiac arrest (OHCA). We hypothesized that this association extends post-discharge in hospital survivors. We investigated whether pre-arrest co-morbidities influence the duration of resuscitation. Methods: We included EMS-treated adult OHCA (Jan 2009 - Dec 2016) from British Columbia Cardiac Arrest Registry and provincial databases. Pre-OHCA characteristics were compared by ≤ 10, 10-20, and &gt;20 min CPR-to-ROSC interval categories. Outcomes included survival and functional outcomes at hospital discharge and 1-year, as well as 3-year post-discharge survival. We examined the relationship between CPR-to-ROSC interval categories and 1 and 3-year survival using Kaplan-Meier (KM). We examined the relationship between the CPR-to-ROSC interval (continuous variable) with all outcomes using regression models. Results: Among 10,241 OHCA, 4604 (45%) achieved ROSC, with a median CPR-to-ROSC interval of 15.5 (IQR 9.0- 22.9) min. Diabetes, chronic kidney disease, and prior MI were associated with longer CPR-to-ROSC intervals. 1245 (12.2%) survived to hospital discharge. Among hospital survivors, KM survival at 1- and 3- years were 92% [95% CI 90-93%] and 84% [95% CI 82-86%] respectively; survival curves stratified by CPR-to-ROSC intervals were not statistically different (Figure). Longer CPR-to-ROSC interval was non-linearly associated with lower survival and functional outcomes at hospital discharge but not with post-discharge outcomes. Conclusion: Longer CPR-to-ROSC interval was associated with lower survival at hospital discharge and is influenced by pre-arrest co-morbidities. However, these intervals were not associated with long-term survival or functional outcome among hospital survivors, suggesting that the early risk of longer CPR-to-ROSC intervals does not persist.
Abstract 10523: Involvement of Sur2/Kir6.1 In the Physiopathology of Pulmonary Arterial Hypertension
Authors: Hélène Le Ribeuz, Bastien Masson, Mary Dutheil, angele boet, Antoine Beauvais, Jessica Sabourin, Vincent Thomas de Montpreville, veronique capuano, Olaf M Mercier, Marc Humbert, David Montani, Fabrice Antigny
Journal: Circulation (2022)

Introduction: The ATP-sensitive K+ channels (KATP) regulatory subunit ABCC8 may be considered a new therapeutic target for pulmonary arterial hypertension (PAH). Hypothesis: We hypothesised that the second KATP regulatory subunit (ABCC9) contributes to PAH pathogenesis. ABCC9 gene encodes for two regulatory subunits of KATP channels: the SUR2A and SURB proteins. In the KATP channel, the SUR2 subunits are associated with the K+ channel Kir6.1. We investigated how the SUR2/Kir6.1 channel contributes to PAH pathogenesis and its potential as a therapeutic target against PAH. Methods: Using in vitro, ex vivo, and in vivo approaches, we analysed the localisation and expression of SUR2A, SUR2B, and Kir6.1 in pulmonary vasculature of controls and patients with PAH as in experimental PH rat models and its contribution to PAH physiopathology. Finally, we deciphered the consequences of in vivo activation of SUR2/Kir6.1 in the monocrotaline (MCT)-induced PH model. Results: We demonstrated that SUR2A, SUR2B, and Kir6.1 were expressed in the lungs of controls and patients with PAH and MCT-induced PH rat model. Myograph experiments showed that activation of SUR2 by pinacidil induced pulmonary arterial relaxation. In vitro experiments on human pulmonary arterial smooth muscle cells and endothelial cells (hPASMCs and hPAECs) in controls and PAH patients showed decreased cell proliferation and migration after SUR2 activation. Using patch-clamp, we demonstrated that SUR2 activation in rat right ventricular (RV) cardiomyocytes reduced RV action potential duration. Chronic pinacidil administration in control rats increased heart rate without changes in hemodynamic parameters. Finally, in vivo pharmacological activation of SUR2 on MCT-induced-PH rats showed an improvement of PH during the preventive and curative protocol. Conclusions: We demonstrated that SUR2A, SUR2B, and Kir6.1 were expressed in hPASMCs and hPAECs of controls and PAH patients. In vivo SUR2 activation reduced MCT-induced PH phenotype, suggesting that SUR2 activation should be considered for treatment of PAH.
Abstract 10411: Low Rate of Major Adverse Cardiovascular Events in Patients Presenting to Urgent Care With Chest Pain and a Moderate HEART Risk Score Who Were Referred for an Expedited Outpatient Cardiology Evaluation
Authors: Svetlana Barbarash, Dolores Lebron-Gallagher, Hollis Julson, Michael Weinstock
Journal: Circulation (2022)

Introduction: The HEART score is an effective method of risk stratifying emergency department (ED) patients with chest pain. The low rate of major adverse cardiovascular events (MACE) in patients with a moderate risk HEART score referred from an urgent care (UC) center for an expedited outpatient cardiology evaluation was first described by this group in 2020. This is a follow up study with a total of 446 patient over a 36 month period. Hypothesis: Patients with a moderate risk HEART score who present to the ED are usually hospitalized for further evaluation. The safety of outpatient evaluation of these patients is not well studied. We assessed the hypothesis that there is a low rate of MACE when patients with a moderate risk HEART score were referred from an UC for an expedited outpatient cardiology follow up. Methods: A cross sectional study was performed from 2/14/2019 through 3/30/2022 in 5 UC centers of 446 patients who presented with chest pain or anginal equivalent and a HEART score of 4 to 6 in Las Vegas, Nevada. A streamlined disposition protocol was adopted by all UC providers for an expedited outpatient cardiology instead of ED referral. The population was followed for 6 weeks with a primary endpoint of MACE (death, myocardial infarction (MI), revascularization) determined by electronic medical records review and direct phone contact with patients. Outcomes were confirmed in 93% of patients. Results: The average age was 65 years with 52% female and 48% male. 395 patients (89%) were seen by a cardiology provider, 346 patients (88%) were seen within 3 days. 265 stress tests (67%), 42 coronary CT angiograms (11%) and 19 invasive coronary angiograms (5%) were ordered. 8 patients (2%) were found to have MACE: 2 had routine surgical revascularization, 4 had non-fatal MI followed by revascularization, 2 patients died: 1 was urgently referred for mitral valve replacement and died after surgery from renal failure and COVID, the other patient died from COVID pneumonia. There were no ischemic cardiac deaths. Conclusion: In conclusion, patients with a moderate risk HEART score referred from UC for an expedited outpatient cardiology evaluation had a low rate of MACE and no ischemic cardiac deaths due to delay of care.
Abstract 10806: Ten Year Atherosclerotic Cardiovascular Disease Risk in Mid Life Predicts Late-Life Amyloid and Tau Deposition on Brain Imaging
Authors: Anum Saeed, Justin Swanson, Oscar L Lopez, Michael Vu, Mark Mapstone, Ann Cohen, Steven Reis
Journal: Circulation (2022)

Introduction: Risk factors of ASCVD have been associated with Alzheimer’s disease (AD) dementia. This association may be mediated by arteriosclerosis (ART), which have been implicated in incident dementia. However, the relationships among ASCVD risk factors, ART, and AD brain biomarkers (amyloid and tau) remains elusive. We investigated the association of the mid-life 10y ASCVD risk and subclinical ASCVD with late-life AD pathology. Methods: Participants &gt;65y enrolled in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study between 2003-2005 (mid-life) underwent brain PET scans in 2018-2020 (late-life) to detect and quantify AD-specific amyloid [Pittsburgh Compound B (PiB)] and tau deposition. Mid-life 10-year ASCVD risk was categorized as borderline (5%-7.4%), intermediate (7.5%-14.9%), or high (≥15%). Logistic regression was used to calculate OR (95% CI) for association of late-life cortical amyloid and tau with mid-life ASCVD risk and marker of ART (vascular stiffness). Results: In 135 participants (mean age ~79y), global tau uptake had a graded association with increasing mid-life ASCVD risk categories (OR ASCVD high vs low risk% 11.00 [2.82-47.49]; p&lt;0.05 ) while no significant association was found with PiB uptake on PET (Table) after mean 16y follow up. In fully adjusted models, Tau uptake was mainly driven by Black race ( OR 10.07 [3.25-36.39] ) and age ( OR 1.24 [1.10-1.41] ); all p&lt;0.05. Midlife vascular stiffness showed a trend of association with late-life PiB retention (OR 1.76 [0.71-4.30]; p 0.05) but not with Tau . Conclusions: In an asymptomatic middle-aged biracial cohort, 10y ASCVD risk was predictive of late-life tau deposition but not amyloid. Vascular stiffness did not independently predict AD pathology. A simple mid-life ASCVD risk calculation may predict late-life AD risk. Further mechanistic studies are warranted to elucidate the race-related differences in the links between ASCVD risk and Alzheimer’s disease.
Abstract 10721: Pharmacologic Management of Bradycardia During Rotational Atherectomy: A 10-Year Veterans Affairs Experience
Authors: Megan Minchak, Emily Ramsayer, William C Mostertz, Matthew C Evans, Carson M Keck, Nodia Robinson, Marissa Aldridge, Chris Nielsen, VALERIAN Fernandes, Anbukarasi Maran
Journal: Circulation (2022)

Introduction: Rotational atherectomy (RA) is frequently used for plaque modification in patients with calcified coronary lesions. RA use in dominant artery lesions is often associated with transient bradyarrhythmias, thought to be due to adenosine release from injured erythrocytes. As such, prophylactic transvenous pacemakers (TVP) are often placed, increasing risk of bleeding and tamponade. We hypothesize that patients undergoing RA at risk for bradyarrhythmias can be safely managed with non-selective adenosine receptor antagonists without routine prophylactic TVP use. Methods: We retrospectively identified 384 consecutive patients who underwent RA at the Ralph H. Johnson VA Medical Center between January 2011 and September 2020. Patients were divided into those pretreated with aminophylline or theophylline (n=147) and those who were not. Primary and secondary endpoints were breakthrough bradyarrhythmia requiring acute pharmacologic or TVP rescue and a composite of 30-day cardiovascular mortality, readmission, and permanent pacemaker implantation. Results: A total of 319 patients who underwent 358 RA procedures met our inclusion criteria. None of the patients had a prophylactic TVP. Overall, 25 patients (6.9%) developed bradycardia, all successfully managed pharmacologically without TVP rescue. Of those pretreated, significantly more patients (12.2%) developed breakthrough bradycardia compared to the 3.3% that did not receive pretreatment (P value 0.001). RA on a dominant vessel was the only significant risk factor among those who developed bradycardia. There was no difference in the secondary endpoint between those pretreated with a non-selective adenosine receptor antagonist compared to those that were not (P value 0.09). Conclusion: Plaque modification with RA can be safely done without routine prophylactic TVP use with favorable acute procedural and short-term outcomes with aminophylline or theophylline pretreatment. There is a significant risk of breakthrough bradycardia with RA on a dominant vessel that can be easily managed medically.